The American Association of Pediatrics (AAP) added fuel to the ongoing pacifier controversy in 2005 with the release of a report and new pacifier guidelines. The report states: "Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised statement recommends the use of pacifiers at naptime and bedtime throughout the first year of life."
Pacifier and SIDs Research
Dr. DeKun Li, a research scientist with Kaiser Permanente's Northern California Region, has studied pacifiers and SIDS. His study finds pacifier use during sleep reduces the risk of SIDS by as much as 90 percent. "Pacifier use could be a useful and simple tool as a public health intervention to further prevent SIDS, like changing a baby's sleep position," says Dr. Li. "The discovery that by placing a baby on his or her back during sleep could prevent SIDS, and the subsequent public health intervention through the Back to Sleep campaign, already has led to almost a 50 percent reduction in the incidence of SIDS. This is considered a public health miracle. However, the incidence of SIDS is no longer declining. There is still substantial SIDS risk for infants up to 9 months of age. If pacifier use can further prevent SIDS, then we potentially have another effective public health intervention."
Experts aren't sure why pacifiers reduce the risk of SIDS. It may be because the pacifiers keep the airway open during sleep, or perhaps babies sleep more lightly because they are sucking. Or maybe babies are less likely to roll over onto their stomachs with a pacifier in their mouths. So far, these are only speculations and further research will be necessary to determine exactly what the reason is.
Dr. Ari Brown, pediatrician and co-author of Baby 411, says this shouldn't be of grave concern. "The American Association of Pediatrics SIDS Task Force reviewed a large number of studies done on SIDS, as well as pacifiers and breastfeeding, dentition, and ear infections," says Dr. Brown. "After reviewing the literature, they felt that the evidence was there that did not prove a decrease in breastfeeding duration simply because babies were given pacifiers (there were other variables that may reduce the length of breastfeeding). They did, however, feel it was important to delay offering a pacifier until 1 month of age to be sure that breastfeeding was well established first."
Dr. Brown recommends breastfeeding moms wait at least a week to offer a pacifier (if they choose to use one) because babies are just learning how to suck, and it may interfere with their technique at the breast. "I also encourage moms to learn Baby's hunger cues so they do not put a pacifier in when the baby really just needs to nurse," says Dr. Brown. "I think that pacifier use and breastfeeding are not mutually exclusive (i.e., they can both happen successfully). But I also tell parents to know when to stop using a pacifier. Even with the new SIDS recommendations, the highest risk of SIDS is between 2 to 6 months of age."
It has been said for many years that pacifiers may cause dental problems. It is now thought the problems lie in how long the pacifier is used. The American Dental Association's recommendations state pacifier use under 1 year of age is not associated with permanent tooth malocclusion/cross bite. "Tooth malocclusion is a potential issue for those toddlers who still use them," says Dr. Brown. "I think 6 months [of age] is a good time to get rid of it."
Finding the Right PacifierFinding the right pacifier can be an exercise in trial and error. "The clips with the ribbons to keep the pacifier nearby is a no-no if a baby is left alone with it," says Dr. Brown. "Pacifiers which have two pieces are potentially dangerous. I recommend one-piece pacifiers ... because they are safe and most like Mom's nipple."
Though pacifier use is an individual decision, the AAP report makes a very compelling reason to consider using one, at least for Baby's first six months.